by Sarah Perry
2
In his rooms on the Pentonville Road, sleeping off bad wine, Dr Luke Garret was woken by a tumult beneath his window. A running boy had brought a message, and stood obstinate on the doorstep awaiting a response. Opening the folded sheet of paper, Garrett read:
Suggest attend wards immediately. Patient presents with stab incision left-hand side above fourth rib (police notified). Wound measuring one and one eighth of an inch, penetrating through intercostal muscle to the heart. Primary examination suggests cardiac muscle undamaged; incision to pericardial sac (?). Patient male, twenties, conscious and breathing. Possible candidate for surgical intervention if attended within the hour. Anticipate your arrival and will prepare accordingly – Maureen Fry.
He gave such a bellow of joy that the waiting boy, startled, abandoned all hope for a tip and slipped back into the crowd. Alone among the hospital staff (saving always Spencer), Sister Maureen Fry was Garrett’s champion and confidante. Thwarted in her own desire to take up knife and needle, she saw in Garrett’s disruptive fierce ambition a proxy for her own. Her long service and formidable intellect, combined with an implacable serenity wielded as a weapon against the arrogance of men, caused her to seem as essential to the hospital’s structure as any of its supporting walls. Garrett had grown used to her near-silent attendance in the operating rooms, and suspected (though was never so certain as to be able to thank her) that to have her as ally had permitted him to attempt several operations which might otherwise have been considered too grave a risk. And none came so burdened with risk as this: no surgeon had ever made a successful attempt to close a wound to the heart. The impossibility of doing so had become attended by romance and legend, as if it were a task set by a goddess no-one could ever hope to placate. Less than a year before, one of the most promising surgeons in an Edinburgh hospital, believing he could remove a bullet from a wounded soldier’s heart, had lost his patient on the table, and in his shame and grief gone quietly home and shot himself. (He’d aimed, of course, for the heart; but with a shaking hand misjudged the aim and died of an infection.)
None of this occurred to Luke Garrett, there on the sunlit doorstep with the sheet of paper held to his chest. ‘God bless you!’ he roared at the baffled passers-by, meaning both patient and nurse, and whoever had so conveniently wielded the knife. He put on his coat – he patted his pockets – his money was gone on drink, and there was none remaining for a cab. Laughing, he ran full-tilt the mile to the hospital gate, shedding with each step the last of the night’s dreariness, and on arrival found himself expected. His entrance to the ward was blocked by a senior surgeon with a beard the colour and shape of a garden spade, who more or less braced himself in the doorframe. Beside him, looking anxious as he so often did, Spencer stood with his hands raised in a placating gesture, now and then gesturing to the note he held, which Luke saw clearly to have also come from Sister Fry. Behind them both a door was opened and pulled quickly shut, though not before Luke glimpsed a pair of long, narrow feet extended beneath a white sheet.
‘Dr Garrett,’ said the older surgeon, tugging at his beard: ‘I know what you are thinking, and you cannot do this – you cannot.’
‘Can’t I?’ This was said so mildly that Spencer drew back in alarm. There was, he knew, no mildness anywhere in Luke. ‘What’s his name?’
‘I mean that you both cannot, and you must not. His family is with him: let him reach the end in peace. I knew someone would send for you!’ He wrung his hands. ‘I will not let you bring disgrace on this hospital – his mother is with him, has not stopped talking since she came in.’
Garrett took a step further, and smelt a kind of onion ripeness coming from the surgeon, and above it the consoling reek of iodine.
‘Tell me his name, Rollings.’
‘You’ve no use for his name whatever. When I discover who sent for you … you’re not going in. I will not let you. No-one ever treated a wound of the heart and had the patient live, not all the better men than you. And he is a man – he is not one of your dead toys – and think of the reputation of the hospital!’
‘My dear Rollings’ – this was said with such exquisite politeness that Spencer fairly recoiled – ‘you could not stop me if you tried. I will waive my fee, if they give me permission; and they will, because they will be desperate. Besides: the Royal Borough has no reputation at all save the one I’ve given it!’
Rollings shuffled in the doorway as if he wanted to swell to fit each corner and turn to steel, flushing such a deep and meaty red Spencer came near in fear that he might faint. ‘I am not speaking of rules,’ he said: ‘I’m speaking of a man’s life – it is not possible – you will ruin your reputation – it is his heart! It is his heart!’
Garrett had not moved, only seemed in the dim corridor to have grown not larger but more massy, more dense: he had not lost his temper, but seemed almost to thrum with a great store of energy barely suppressed. Rollings sagged against the wall: he knew himself bested. Passing him with a look that was almost kindly, Garrett crossed swiftly into a small room, scrupulously clean. The bright antiseptic air smelt of carbolic acid, and of lavender scent rising from the handkerchief drawn through the hands of a woman seated by the patient’s bedside. She leaned forward at intervals, confidingly, whispering to the man beneath the white sheet: ‘Shouldn’t think you’ll be long off work – we won’t bother them yet.’
Maureen Fry, in a dress starched stiff as card and thin rubber gloves, stood at the window adjusting a cotton blind to let the late sun in. She turned to greet the men with a placid nod: if she’d heard the intemperate wrangling just beyond the closed door it was clear she’d never acknowledge it. ‘Dr Garrett,’ she said; ‘Dr Spencer. Good afternoon. You of course will prepare before examining the patient, who is doing nicely.’ She handed Spencer a small file on which was recorded the declining pulse, the peaking temperature. Neither Garrett nor Spencer were fooled by a form of words calculated to convey nothing at all to the mother: he was not doing nicely, and likely never would again. ‘His name is Edward Burton,’ she said: ‘Twenty-nine, and in good health: a clerk in the Prudential Insurance Company. He was attacked by a stranger as he walked home to Bethnal Green; they found him on the steps of St Paul’s.’
‘Edward Burton,’ said Luke, and turned to the man beneath the sheet.
He was so slight that he hardly lifted the white cloth covering him, but tall, so that his feet and shoulders were visible. His collarbones were sharp, and between them the declivity of his throat fluttered visibly. Spencer thought: He’s swallowed a moth, and felt sick. A high colour spread across the patient’s cheeks, which were broad and high, and marked with moles in black clusters. His hair had begun to recede early, leaving a white stretch of forehead on which beads of sweat stood out. He might have been twenty; he might have been fifty; he was probably more beautiful at that moment than he had ever been before. He was conscious, and had about him an air of great concentration, as if the expelling of breath were a skill that had taken years to perfect. Listening carefully to his mother, he interjected where she paused, but only to say something about crows and rooks.
‘He was all right a few hours ago,’ said his mother, apologetically, as if they’d missed seeing him at his best and would go away disappointed. ‘They put a plaster on. Can you show them?’ The nurse lifted first the thin arm, and then the sheet. Spencer saw a large square plaster fastened over the left nipple and extending a few inches down. There was no blood or suppuration: it looked as if a cloth had been draped over him as he slept. His mother said, ‘He was all right when they brought him in. He was talking. They patched him up a bit. There wasn’t much bleeding, there wasn’t much of anything. They put him away in here out of sight and I think they forgot about us. He’s just getting tired, that’s all. Why didn’t anyone come? Why can’t I take him home?’
Gently, Luke said: ‘He is dying.’ He left the word in the air a while to see if she’d take it up, but she only smiled uncertainly, as if it
had been a joke in poor taste. Luke crouched by her chair, and touched her lightly on the hand, and said, ‘Mrs Burton, he’s going to die. By morning, he’ll be dead.’
Spencer, who knew how eagerly Luke had awaited a wound like this – had seen dogs and corpses cut and probed in preparation, and once let Luke stitch and restitch a long cut of his own to perfect his needlework – saw his friend’s patience with astonishment and love.
‘Nonsense!’ the woman said, and they heard the fabric of her handkerchief tear between her fingers. ‘Nonsense! Look at him! He’ll sleep it off!’
‘His heart is cut. The bleeding is all in there, all in here’ – Garrett thumped his own breast – ‘his heart is getting weak.’ Reaching for words she might understand he said, ‘It will get weaker and weaker like an animal bleeding in the forest, and then it will stop and there’ll be no more blood anywhere in him, and everything – his lungs and his brain – will starve.’
‘Edward –’ she said.
Luke saw the blows land, and that his prey was weak; laying a hand on her shoulder he said: ‘What I mean is – he will die, unless you let me help.’
There was a moment of struggling against the truth, then she began to cry. In a quiet voice that carried through the weeping with more authority than Spencer had ever seen him muster, Luke said, ‘You are his mother: you brought him into the world, and you can keep him in it. Will you let me operate? I …’ – his belief in the possibility of success did battle with his honesty, and reached an uneasy truce – ‘I am very good – I’m the best, and I’ll do it without payment. It’s not been done before and they’ll tell you it can’t be done, but for everything there’s a first time and it’s the time that matters most. You want me to promise, I know, and I can’t, but can you trust me, at least?’
Outside the door there was a brief commotion. Spencer suspected that Rollings had alerted various administrative authorities, and leaned against the door with his arms folded. He caught the nurse’s eye, and each conveyed silently Oh we are sailing very close to the wind. The commotion subsided.
The woman said, between gasps, ‘What will you do to him?’
‘Really, it’s not so bad,’ said Luke. ‘His heart is protected by a kind of bag, like an infant in the womb. The cut is there – I have seen it – I could show you? – yes, perhaps you’d rather not. The cut is there, no longer than your little finger. I’ll stitch it up, and the bleeding will stop, and he will – he might – recover. If we do nothing …’ He spread out his hands in a gesture of dismay.
‘Will it hurt?’
‘He will know nothing about it at all.’
She began to gather herself piece by piece, beginning at her feet, which she set a little further apart on the floor, and ending with her hair, which she brushed away from her face as if to show off her newly acquired resolve. ‘All right,’ she said. ‘Do what you like. I’m going to go home now.’ She did not look at her son, only grasped his foot as she passed the bed. Spencer went out with her, to do as he always did: soothe, and placate, and with the authority conferred by wealth and status protect his friend from the consequences of his actions.
Garrett meanwhile stooped over the bed and said briskly, ‘In a little while you’ll have a good deep sleep – are you tired? I think you are.’ Then he took the man’s hand, feeling foolish, and saying, ‘I am Luke Garrett; I hope you’ll remember my name when you wake.’
‘One rook is a crow,’ said Edward Burton, ‘but two crows are rooks.’
‘Confusion’s only to be expected,’ said Garrett, and replaced the man’s wrist on the white sheet. He turned to Sister Fry, and said, ‘Are you able to attend?’ though it was merely politeness, since it was inconceivable that she would not. She nodded, and in that silent response conveyed such quiet confidence in Garrett’s skill that his pulse – not yet settled since running there – began to slow.
When he and Spencer entered the operating theatre, hands raw from scrubbing, the porters had departed. Edward Burton lay high on the bed, eyes fixed on Sister Fry, who’d changed into a fresh uniform and was withdrawing with practised monotony a series of bottles and instruments which she laid out on steel trays.
Spencer would’ve liked to explain to the patient what was to come next – that the chloroform worked slowly and sickly, and that he should not fight the mask, but would wake (would he wake?) in due course, throat aching from the tube through which the ether passed. But Garrett required silence, and both Spencer and the nurse had come to anticipate what he required next by little more than nods and nudges, and how directed were the black looks he gave above the white mask.
The patient immobile, the rubber tube tugging at his lip to give the impression of a sneer, Garrett removed the plaster and surveyed the wound. The tension of the skin had caused it to open in the shape of a blind eye. Burton had so little fat on him that the grey-white bone of the rib was visible beneath the severed skin and muscle. The opening was insufficient, and having first washed the flesh in iodine Garret took his knife and made it larger by an inch in each direction. With Spencer and Fry attending, to suck and swab and keep clear his view, Garrett saw it would be necessary first to remove a section of the rib that covered the wounded heart. With a fine bone-saw (he’d used it once to amputate a girl’s crushed toe, despite her protestations that she couldn’t possibly dance in sandals if she was down to just the four) he cut the rib to four inches shorter than creation intended, and put it in a pan held nearby. Then with steel retractors that would not have looked out of place in the hands of a railway engineer he opened up a cavity and peered within. We’re so tightly packed, thought Spencer, marvelling as always at how bright and beautiful it was. The marbling of red and purplish-blue, and the scant deposits of yellow fat: they were not the colours of nature. Once or twice the muscles all around the opening flexed slowly, like a mouth arrested in a yawn.
And then there was the heart, thrumming in its slick case, the damage seeming so slight. Garrett had promised that the cut was to the case alone and had gone no further, and believed himself truthful, and now with a probing finger saw that he was. The chambers and valves were undamaged: he gave a little cry of relief.
Spencer watched as Luke slipped in his hand – the wrist angled a little, the fingers curved – to cup the heart where he could, to feel it, because (he’d always said, even with the dead ones) it was the most intimate thing, and sensual, and he saw by touch as much as by sight. With his left hand he steadied the heart, and with his right he took from Fry the curved needle threaded with a catgut ligature so fine it would have been fit for wedding silk.
Much later, Spencer would be stopped on the wards and in the corridors and asked: ‘How long did it take? How many stitches were there?’ and he took to saying ‘A thousand hours and a thousand stitches,’ though in truth it seemed he barely breathed in and out again before he heard the grinding of the retractor bolts, and the wet slip of the instrument as it was removed; the muscles at the rim of the open cavity slammed shut, and then it was only the skin being stitched over a hollow place where the rib had once been.
They passed a long hour then, moving about the bedside as opiates replaced chloroform and dressings were fitted and nervously watched for slow or sudden bloomings of blood. Sister Maureen Fry, straight-backed and bright-eyed, as if she could happily have done it all again and then again, passed them water which Spencer could not drink, and which Luke took in draughts that almost made him sick. Others came and went, peering curiously around the door, hoping for triumph or disaster or both, but seeing no movement and hearing nothing went away disappointed.
At the beginning of the second hour Edward Burton opened his eyes and said loudly, ‘I was just by St Paul’s, that was all, wondering how the dome stays up,’ then, more quietly, ‘I’ve got a sore throat.’ To those who’d seen so much of life in ebb and flow, the colour on his cheek and the attempt to lift his head were as telling as any careful daylong chart of pulse and temperature. The sun had gone down
: he’d see it come up.
Garrett turned, and left, and finding one of the many cupboards where linens were stored crouched for a long while in the dark. A dreadful trembling took hold of him, and shook him so violently that only by making a straitjacket of his own arms could he prevent his whole body from throwing itself against the closed door. Then it subsided, and he began instead to cry.
3
William Ransome, walking coatless on the common, saw Cora come towards him. From a distance he’d known at once it was their visitor: she strode like a boy, and seemed always to be pausing to peer at something in the grass, or to put something in her pocket. Low sun lit the long hair loose upon her shoulders; when she saw him, she smiled and raised her hand.
‘Good afternoon, Mrs Seaborne,’ he said.
‘Good afternoon, Reverend,’ said Cora. They paused, and smiled, not taking their greeting seriously, as if long years had passed and made the niceties absurd.
‘Where’ve you been?’ he said, seeing that certainly she must have walked miles: her coat was unbuttoned, her shirt damp at the neck and marked with moss, and she held a stem of cow parsley.
